Piontkovskyi V. К., Holbaum М. B.

DIFFERENCES IN PREOPERATIVE RADIOGRAPHIC PARAMETERS OF THE LUMBOSACRAL SEGMENT AND PELVIS IN THE CASE OF TRANSFORAMINAL AND INTERLAMINAR DISCECTOMY OF L5-S1 INTERVERTEBRAL DISC HERNIATION

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Piontkovskyi V. К., Holbaum М. B.

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CLINICAL AND EXPERIMENTAL MEDICINE

Type of article:

Scientific article

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Deficiencies in preoperative planning of the endoscopic discectomy method (transforaminal or interlaminar) with incorrect assessment of the working canal boundary lead to inadequate neurodecompression with recurrence of disc herniation, intraoperative damage to the superior end plate of the S1 vertebra, and conversion to open microdis cectomy. Aim is to compare the radiometric parameters of the L5-S1 segment and pelvis of patients who underwent successful transforaminal and interlaminar endoscopic discectomy of L5-S1 disc herniation. Object is protocols of clinical and radiological examination of patients after endoscopic discectomy of L5-S1 disc herniation (n=37 after transforaminal discectomy (group A); n=30 after interlaminar discectomy (group B). Methods - clinical, radiological, radiometric, statistical. Analysis of the dynamics of lumbar and referred pain in the lower extremity revealed a signif icant decrease in VASp2 and a reliable (p<0.05) decrease in VASv2 compared with VASp1 and VASv1, respectively, in each patient group. Also, the ODI_2 disabilty levels significantly decreased (p<0.05) compared with ODI_1 in groups A and B. Radiographic studies revealed a smaller inclination angle and a shorter transverse process, a smaller inter laminar width of the L5 vertebra, and a larger intervertebral foramen in group A compared with group B. A signifi cantly (p<0.05) lower position of the iliac crest and a significantly (p<0.05) higher distance between the free edge of the transverse process of L5 and the wings of the sacrum were found in group A compared to group B.

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Bibliography:

1. Jamaleddine Y, Haj Hussein A, Afyouni A, Mayta Z, El Ayoubi LM, Salameh P, et al. Effect of Patient’s Characteristics and Surgical Technique on the Patient Outcomes and Satisfaction After Endoscopic Lumbar Discectomy - A Long-Term Retrospective Study. Journal of Clinical Medicine. 2025;14(5):1411. DOI: 10.3390/jcm14051411.
2. Kwon H, Park J-Y. The Role and Future of Endoscopic Spine Surgery: A Narrative Review. Neurospine. 2023;20(1):43-55. DOI: 10.14245/ ns. 2346236.118.
3. Gao A, Yang H, Zhu L, Hu Z, Lu B, Jin Q, et al. Comparison of Interlaminar and Transforaminal Approaches for Treatment of L5 /S1 Disc Herniation by Percutaneous Endoscopic Discectomy. Orthop Surg. 2021;13(1):63-70. DOI: 10.1111/os.12831.
4. Chen J, Jing X, Li C, Jiang Y, Cheng S, Ma J. Percutaneous Endoscopic Lumbar Discectomy for L5S1 Lumbar Disc Herniation Using a Transforaminal Approach Versus an Interlaminar Approach: A Systematic Review and Meta- Analysis. World Neurosurg. 2018;116:412 420.
5. Tornatore I, Basile A, Aureli A, Tarantino A, Orlando G, Buharaja R. Effectiveness and Safety of Transforaminal Spinal Endoscopy: Analysis of 1000 Clinical Cases. Diagnostics (Basel). 2025;15(8):1021. DOI: 10.3390/diagnostics15081021.
6. Yang JS, Liu KX, Kadimcherla P, Chu L, Deng ZL, Chan YK, et al. Can the novel lumboIliac triangle technique based on biplane oblique fluoroscopy facilitate transforaminal percutaneous endoscopic lumbar discectomy for patients with L5-S1 disc herniation combined with high iliac crest? Case-control study of 100 patients. Pain Physician. 2020;23:305-14.
7. Yang CC, Chen CM, Lin MH, Huang WC, Lee MH, Kim JS, et al. Complications of Full-Endoscopic Lumbar Discectomy versus Open Lumbar Microdiscectomy: A Systematic Review and Meta-Analysis. World Neurosurg. 2022;168:333-348. DOI: 10.1016/j.wneu.2022.06.023.
8. Pojskic M, Bisson E, Oertel J, Takami T, Zygourakis C, Costa F. Lumbar disc herniation: Epidemiology, clinical and radiologic diagnosis WFNS spine committee recommendations. World Neurosurg X. 2024;22:100279. DOI: 10.1016/j.wnsx.2024.100279.
9. Azemi ES, Kola S, Kola I, Tanka M, Bilaj F, Abazaj E. Lumbar Disk Herniation: A Clinical Epidemiological and Radiological Evaluation. Open Access Maced J Med Sci. 2022;10(B):1588-94.
10. Sousa JM, Serrano A, Nave A, Mascarenhas V, Nogueira P, Gamelas J, et al. Transforaminal Endoscopic Approach to L5S1: Imaging Characterization of the Lower Lumbar Spine and Pelvis for Surgical Planning. World Neurosurg. 2023;175:e809-e817. DOI: 10.1016/j. wneu.2023.04.026.
11. Bae J, Chachan S, Shin S-H, Lee S-H. The isthmic corridor - a novel anatomical approach for L5-S1 postero-lateral endoscopic lumbar discectomy (PELD). Interdisciplinary Neurosurgery. 2020;20:100656. DOI: 10.1016/j. inat.2019.100656.
12. Zheng B, Yu P, Ma K, Liu H, Liang Y. Percutaneous Endoscopic Lumbar Discectomy via Sacral Ala-Transverse Process Approach for the Treatment of Far-Lateral Disc Herniation at L5/S1: A Technical Note and Case Series. World Neurosurg. 2025;202:124406. DOI: 10.1016/j. wneu.2025.124406.
13. Li J, Chu X, Wan W, Du L, Xu B. Radiographic characteristics-based classification system for percutaneous endoscopic lumbar discectomy surgical approach selection in patients with L5-S1 disc herniation: a hierarchical clustering analysis. Quant Imaging Med Surg. 2023;13(12):8204-8217. DOI: 10.21037/qims-23-277.
14. Song Q-C, Zhao Y, Li D, Zhang YK, Fan LH, Li QY, et al. Percutaneous endoscopic transforaminal discectomy for the treatment of L5-S1 lumbar disc herniation and the influence of iliac crest height on its clinical effects. Exp Ther Med. 2021;22:866.
15. Yang CC, Yeh KT, Liu KC, Wu WT. Ameliorated full-endoscopic transforaminal decompression for L5-S1 foraminal and extraforaminal stenosis. Clin Spine Surg. 2021;34:197-205.
16. Lin A, Wang Y, Zhang H, Zhu K, Zhou D, Guo J, et al. Endoscopic Revision Strategies and Outcomes for Recurrent L4/5 Disc Herniation After Percutaneous Endoscopic Transforaminal Discectomy. J Pain Res. 2024;17:761-770. DOI: 10.2147/JPR.S449949.
17. Krishnan A, Marathe N, Degulmadi D, Mayi S, Ranjan R, Kumar Bali S, et al. End-points of decompression of in lumbar transforaminal endoscopic spine surgery: a narrative review of objective and subjective criteria to prevent failures. J Minim Invasive Spine Surg Tech. 2022;29:68-83. DOI: 10.21182/jmisst.2022.00444.
18. Imoto R, Umakoshi M, Yunoki M, Tatano M, Hirashita K, Yoshino K, Nishimura Y. Surgical Outcomes of Full-Endoscopic Lumbar Discectomy in the Early Adoption Phase. Asian J Neurosurg. 2022;17(3):474-479. DOI: 10.1055/s-0042-1751012.
19. Zhao Y, Yuan S, Tian Y, Liu X. Necessity of routinely performing foraminoplasty during percutaneous endoscopic transforaminal discectomy (PETD) for lumbar disc herniation. Br J Neurosurg. 2023;37:277-83.
20. Kapetanakis S, Chatzivasiliadis M, Gkantsinikoudis N, Pazarlis K. Full-Endoscopic Lumbar Discectomy: A Review of the Surgical Techniques, Indications and Anatomical Considerations. Journal of Clinical Medicine. 2025;14(24):8961. DOI: 10.3390/jcm14248961.
21. Min JH, Kang SH, Lee JB, Cho TH, Suh JK, Rhyu IJ. Morphometric analysis of the working zone for endoscopic lumbar discectomy. J Spinal Disord Tech 2005;18:132-135.
22. Assis R, Nascimento W, Toulias A, De Abreu Oliveira D, Reck de Mendona PT, Wirth F, et al. Transiliac endoscopic access for transforaminal approach at L5-S1: cases report. Coluna. 2024;23:4. DOI: 10.1590/S1808-185120242304291340.

Publication of the article:

«Bulletin of problems biology and medicine», 2026 Issue 1, 180, 318-327 pages, index UDC 616-073.756.8:616.711.6.721.1-089.87

DOI:

10.29254/2077-4214-2026-1-180-318-327